By and For Those With Private Disability Claims

Unum Targeting HIV As Mental and Nervous

There are recent reports that Unum may be focusing on HIV claims and limiting benefits to 24 months due to mental and nervous impairment. Boy, does this sound familiar since it’s the same Unum scam the company played with cardiac claims classified as mental and nervous.

In the past, Unum took giant leaps by alleging most cardiac claims were actually mental and nervous beyond a reasonable recuperative period. For example, insureds recuperating from recent heart surgery were allowed 12+ weeks to recover and return to work. Beyond that, insureds were classified as mental and nervous particularly if they began therapy as part of the rehabilitation process. Claims management could always depend on profit results from aggressively attacking psyche/cardiac claims and alleging “depression” was the primary diagnosis preventing claimants from returning to work.

The problem with this strategy was that not everyone physically heals at the same rate and “reasonable ERD (Expected Recovery Date) recovery periods” were not accurate indications of ability to return to work.

Likewise, in the last decade, Unum appears to also risk manage HIV/AIDS claims as mental and nervous alleging HIV medications are so successful that most HIV insureds could return to work in some capacity if they wanted to. Although it seems reasonable HIV patients might benefit from counseling, “depression” is generally NOT the primary diagnosis precluding work.

While it is true third and fourth generation HIV drugs are more successful in promoting health, HIV patients continue to suffer from a wide variety of medication side-effects, diarrhea, neuropathies, cognition problems, and fatigue. T-cell counts of 500 or above might show close to health in the lab, but in real life the co-morbidity of remaining symptoms makes HIV patients unreliable to compete in work environments that demand 40-hours+ per week with above exceeds performance. It isn’t possible for most HIV insureds to return to work full-time, and Unum knows it.

Most HIV patients treated for “depression” are treated as “secondary to physical disease.” Despite Unum’s awareness that HIV with secondary depression should be treated as a “physical” cause of disability, the company often opts to rename the disability as mental and nervous in order to benefit from a limited pay period of 24 months.

This is consistent with Unum’s patterns of practice of supporting claims decisions with a financial profit conflict of interest using internal reviews that are medically unsound and generally not supported by other HIV physicians. For example, a HIV patient with a T-cell count of 200 would most likely not be able to return to the workplace even if he/she was receiving treatment for depression.

Of late, Unum is taking advantage of every possible strategy in order to deny more claims including reclassifying HIV (a physical disability) as mental and nervous. In my opinion, Tom Watjen’s reports of Unum’s financial strength are a direct result of implementing bad faith strategies in order to increase denials or limit benefits to 24 months.

He isn’t really pulling the wool over anyone’s eyes when the company continues to engage in unfair claims practices in order to make more money.

HIV/AIDS is primarily a physical impairment, not a mental one– and Unum knows it.